Request for Internet Services Representatives Payee Report

ICR 200212-0960-012

OMB: 0960-0668

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
ICR Details
0960-0668 200212-0960-012
Historical Active
SSA
Request for Internet Services Representatives Payee Report
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 02/28/2003
Retrieve Notice of Action (NOA) 12/27/2002
Approved for use through 8/2003 under the condition that any subsequent submissions for OMB review include an explanation of SSA's efforts to combine under one OMB approval number the inter- net and hard copy versions of this form. In addition, SSA must submit for PRA review any amendments to the POC evaluation questions.
  Inventory as of this Action Requested Previously Approved
08/31/2003 08/31/2003
4,700 0 0
1,175 0 0
0 0 0

SSA is developing an Internet Representative Payee Report form (I623) to electronically report use of benefit payments made on behalf of Social Security beneficiaries and SSI recipients. During the projected 6-month POC, participating organizations will use the Internet to complete and file the representative payee report instead of using the paper SSA-623. The information collected will be used to determine whether the payments have been administered in the best interest of the beneficiary.

None
None


No

1
IC Title Form No. Form Name
Request for Internet Services Representatives Payee Report

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 4,700 0 0 4,700 0 0
Annual Time Burden (Hours) 1,175 0 0 1,175 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
12/27/2002


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